Hem/onc fellow, how to decide on career path

[Smallmelon]

Hi, i’m about to finish 1st year hem/onc fellowship in a mid-tier academic program. Also have a PhD in cancer biology with publications (in colon cancer). No visa issue. I’m having a hard time in choosing my career path.

The things that I value most is lifestyle and pay. I have 2 young children to support.

So far, I know I like treating solid tumors, but do not have a specific disease that dominate my interests. Our program is clinically heavy in 1st year, so far I did not do any meaning research during my first year.

Program has been pushing us to make decision about which career path to choose. Private practice, semi-academia, versus academia, which one can offer a better lifestyle and payment? Feeling a little lost.

Appreciate any input!

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[OncOnc321]

In similar situation, trying to answer questions honestly about what I want with my life. This is how im looking at things. Im also a fellow so would appreciate to hear what experienced docs think.

Academics = starting $160-200k, maybe get to mid-upper $200k in next 10 years.
Clinic 1-2 days per week. Still trying to figure out how busy attendings are the other 3-4 days. I think there is a large range of variability with some working a ton and others leaving work early every day. Another perk is very little home call. Also less weekends compared to private practice. I think there is potential to have a pretty cush job but it would have to be at the right institution with a laid back culture. You can get some money from pharma but I have no idea what would be a realistic amount and what type of time commitment would be required. Even if you are in with pharma, im confident you would still be making less money than private practice.

Private practice = start $250-350, get anywhere to $400-700k in next 5 years, depending on how much you want to work.
It sounds like a lot of people have clinic Mon-Thurs and do admin, calls etc on Friday. I would imagine these are all fairly busy days. Even though you will take home call more frequently, I have heard home call is not too bad when you are covering for just 4-5 docs or your own patients. One onc in private practice told me they have been woken up 2 times at night over the last three years and both times it was for good reason.

Hybrid (aka work as a staff physician for a university) = Pay $300-400k. Probably not expect big pay increase next 5-10 years. You would make way more being partner in a private practice. I think lifestyle is similar to private private, maybe a little better. I imagine less push to be productive and meet rvu goals compared to private practice (thus less $$). You take your own patient calls. Your group probably covers affiliated hospitals on the weekend. Any really sick or complicated patients that show up in your clinic or hospital can be transferred to the main campus. You can still enroll patients on clinical trials.



If I were to choose right now, I would do a hybrid or private practice job and try to work 3 clinic days per week. Maybe start around $200-$250 but work up to $350 in next 2-3 years. I think this would allow enough time to spend with family and still be plenty of cash. Not sure if finding a hyrbid or private practice job that would have me work 3 days a weeks is realistic. Interested in hearing what others think.

 

[Vidared]

Does anyone have any thoughts on starting a career in a hybrid/private practice for a few years before transitioning to an academic position? I may have to take a position in community practice but I've always wanted to be in academia (which may not be an option because of my visa)

 

[Tigermt]

Typically, what is the starting salary for private practice in NJ (suburbs) and income potential? Thanks!

 

[bobow98]

Typically, what is the starting salary for private practice in NJ (suburbs) and income potential? Thanks!

Tree fiddy
minus 60-80 k

 

[gutonc]

Does anyone have any thoughts on starting a career in a hybrid/private practice for a few years before transitioning to an academic position? I may have to take a position in community practice but I've always wanted to be in academia (which may not be an option because of my visa)

It's tough, but do-able. You may also find that you want out of academia after giving it a go.

The key is going to be making sure that you maintain involvement in "academic" things. Join a group with a robust clinical trial program (they are out there) and be the local PI on a few industry trials. Work with the local academic center (assuming there is one) to partner with somebody there doing an IIT or translational work (it's a win-win...you get more academic cred, they get more patients on study). If you have the opportunity to do so, teach (students, residents, fellows). Some of the hospitals you are going to have privileges at will have IM or FM residency programs and may want (FM) or need (IM) hem/onc rotations for their residents, be that guy and be the best sub-specialty teaching attending they have.

To be clear, these are all specific examples from my group. We have a large clinical trial trial portfolio (currently 20+ open) and the staff to support it. Two of us are either lead PI or co-lead PIs on some of these studies and have given platform presentations or been first author on publications because of them. One of may partners is the "teaching guy" and has students (affiliated med school) and residents (community hospital where we practice) with him almost constantly. He's won teaching from both the med school and the residency (which recently took him out of the running after he won it 5 years in a row).

The flip side of this is that you might get into a community job and realize you really just like taking care of patients. Or you might go community, then get an academic job and then decide the community job was better for you after all (I'm writing an offer letter for that dude to join our practice right now).

Whatever you decide or make work, good luck.

 

[tenandone]

I'm currently an IM resident- last year i went into intern year excited and everything was fascinating. this year, much less fascinated but some good moments. I am torn between hematology/oncology and cardiology. This is the list of pros and cons I made up, but am still struggling to pick one. I need to pick one soon though. some input on outpatient/inpatient balance and salary (definitely not the deciding factor, but plays a significant role given i solely will be responsible for earning.

Heme/Onc:
pros:
-time with my patients
-no real emergencies
-diversity of pathology
-novel treatments
-if i have a family, i can have somewhat of a predictable schedule

cons:
-rare that one doesn't specialize within heme/onc, thus mitigating effect of diversity of pathology
-do not like outpatient medicine as sole part of practice
-want inpatient based career, with a couple days of clinic or change in environment

Cardiology:
pros:
-dynamic environment involving inpatient and outpatient
-i like that the pathology is logical
-superficial but like that i'd follow in the footsteps of a parent, who is also my mentor

cons:
-i still cannot read ekg for the life of me
-only 4 or 5 main pathologies
-not a whole lot of new treatments

 

[gutonc]

I'm currently an IM resident- last year i went into intern year excited and everything was fascinating. this year, much less fascinated but some good moments. I am torn between hematology/oncology and cardiology. This is the list of pros and cons I made up, but am still struggling to pick one. I need to pick one soon though. some input on outpatient/inpatient balance and salary (definitely not the deciding factor, but plays a significant role given i solely will be responsible for earning.

Heme/Onc:
pros:
-time with my patients
-no real emergencies
-diversity of pathology
-novel treatments
-if i have a family, i can have somewhat of a predictable schedule

cons:
-rare that one doesn't specialize within heme/onc, thus mitigating effect of diversity of pathology
-do not like outpatient medicine as sole part of practice
-want inpatient based career, with a couple days of clinic or change in environment

Since this is the Hem/Onc forum, I'll comment on your pro/con list for that only. Your pro list is pretty spot on. Except maybe the time with patients. I get 15min for a f/u regardless of what's going on, unless I request more in advance. I see a lot of my patients pretty frequently though, so maybe that makes up for it.

As for the cons, the only people who super specialize are in academics and very large groups where you can afford to have a "GI gal" and a "Lung guy" because you've got 12 other docs in the practice. Most community based jobs (which is to say, most jobs) are for generalists in smaller groups. So the diversity of pathology is there.

I think the bigger issue is wanting inpatient over outpatient. Unless you want to do heme mal/transplant/CAR-T, the vast majority of your work in hem/onc will be outpatient, with a few inpatient consults. And even that stuff is getting moved to the outpatient setting for cost purposes. So unless you want to do leukemia, or be the Hem/Onc hospitalist somewhere (in which case, don't waste your time on a fellowship), you're going to be an outpatient doc in Hem/Onc.

 

[IMres85]

Is 350k for first two years at a private practice in rural southeast reasonable? Following that it is partnership and is based off production with the average partner making > 550k. Would seem that being in the rural south that the starting compensation would be higher and this seems about average.
Just curious